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Masteries:
3/3 deadliness 1/1 cripple
4/4 alacarity and sorcery
sunder archaic knowledge max
all the way down to havoc not getting: improved rally unless you want it- but as a twitch not a good idea unless in a premade

pick up heal in the def tree and put the points left in def or utility as you think will fit your play style.

Long game with plenty of hero ganking (which you should do at around level 7)
Vamp scepter
Boots+5
Malady
Bloodthirster
Inf Edge or Phantom Dancer or both if game is long enough
black cleaver or bloodthirster
stacking bloodthirsters can carry a team

when you get more confident things like sword of occult are not bad ideas at all.

you get the basic idea

tactics:
at 7 go around to the opposite lanes of you (your bot, go top) and gank, then go bot for a few seconds, then go mid. If they drop wards and your team mates call it out be thankful- buy an oracles and destroy the wards and continue ganking.

push towers while their dead then GTFO- do not stick around, and dont get greedy
versing healy classes think about buying exc calling.- the crit is nice

dont fight 2 healy classes at once

for ult:
be patient, wait for the proper set up. if their are 2 enemies you can probably take them, especially if its late game and they dont have blind, wait for them to group up. think about where you would run to saftey and how, put yourself their, get close (MAKE SURE YOUR IN A STRAIGHT LINE) and spray and pray, if they run backwards to saftey its in a straight line from you and you got them. If they run forwards in a straight line you got them. Dont come at them when all they have to do to get to saftey is strafe- waste of ult and time.

I have tried a large number of different builds with twitch, and the one that has granted me the greatest margin of success, and the only one that has given me any ability to makeup ground from falling behind, is crit%.

Despite what logic may tell you, given the nature of expunge, attack damage is far more powerful than attack speed, the main reason being that in many games, especially against well played teams, you simply do not have time to sit around and take more than one shot before moving along, not to mention you will have no trouble landing 6 shots in between expunge cooldowns even without a single AS item.
Twitch is made of glass and paper, and you will have greater success with him if you play with this in mind.

Also, twitch shines when he can find himself ahead of the gold curve. You do this through early champion kills to snowball your effectiveness. Think him like a sword of the occult made into a character.

I usually start out my game with a doran's blade. This gives him everything he needs early game, which is pivotal, since Twitch, compared to many other champs, is AWFUL early game. Slow attack speed gimps your main damage (expunge), his offenses are nothing special, and his defences are terrible, not to mention low movement speed and subpar attack range compared to say, tristana or ashe. Doran's blade's health, damage, and lifesteal will be a boon to you well through the game, and if things go well, you'll have enough money to make up for the lack of a combine item early on.

for my first item, I either go for a Sword of the Occult, or Avarice blade.
Avarice blade begins the crit build, and helps you a bit with your money advantage, and is extremely cheap. Sword of the occult gimps you before it carries it's stacks, so only get this if you feel your going to be able to get stacks on it soon.
after that, I go for boots, and 2 more avarice blades

the boost are situational, game to game. Use your best judgement. Merc Treads against if your worried about cc and/or magic damage, ninja tabai for physical DPS, 'zerker greaves if you feel your the most awesome thing since sliced bread and only need to kill more better and more faster, yes-yes. It's also worthwhile to concider the 3 movespeed boots if you need to move around a lot in combat (works well with AD/Crit build), or boots of mobility if you need to move around the map alot: that extra movespeed can grant you many a gank in the right game

after your 3 avarice blades and boots, you should either go for lifesteal, or infinity edge
the reason for infinity edge is obvious, but its very expensive. Get this if you have a streak going and feel you can keep grinding suckers into paste
Lifesteal is to help you harrass, and give you a smidge more survivability, that with your massive damage, can make the difference between a succesful gank, and your death.
for lifesteal, you have malady, executioners calling, and bloodthirster to choose from

Bloodthirster is good in a similar situation to infinity egde
Exec. Calling is cheap, and will also help you gank healers
Malady is of questionable worth, but many enjoy it on twitch. Its also quite powerful with your ult, but if your team has a substantial amout of phys dps on it, I would recomend Starks Furvor instead (at this point in the game, solo ganking should either be rare, or so easy the power lost in the item in exhange for its aura wont matter)

From there, if the game isnt over, evaluate your impact on the battlefield. If you need to live longer, get a banshees veil, or maybe even a defensive item, ideally one that slows attackers movement and attack speeds
alternatively, you can get phage/frozen mallet

if you need to keep hurting things more harder to kill them more faster, get whichever of infinity edge or bloodthirster you didnt get before, and quaff green elixers.

For builds, go offense for that damage increase, and defence for the dodge/movespeed increase. Grab the 15% magic pen on your way up offence to make your expunge hit harder.
reflect this in your rune choices with AP reds, and dodge yellows. Blues, I havn't made up my mind yet.
for summoner spells, Exaust is lovely with its combined offensive and defensive use. For the other, Id recomend ignite if your really confident, or flash/ghost if your not, or rally.

Playing the champ, think of yourself like a fragile little turret, and wait for the best possible position before popping out of stealth. Ideally, you will join teamfights late, and turn their tide hard enough to make people post in these boards about how OP you are. Mess up this positioning, you will be a free kill, and your team will yell at you for feeding.

When you dont have such a luxery, keep moving, and plink shots to harrass until **** really goes down. Keep in mind that they will want to target you first, and again, wait for the proper moment to strike. Distraction, exposed carry, whatever.
if they dont give you a proper moment, you can always pop your ult and seige them fro ma distance.

He's a deceptively tricky champ. Often, you'll feel useless walking around the edges of combat, sure that if you step close enough to take a shot you'll die, and when you finally do take that shot, you'll die.
Always be looking for your opportunity. When you capatalize on that opportunity, you are a godly force to be reckonned with. When you don't, your free XP and gold.
late game, when the dps gets to be so harsh you find yourself dead in the blink of an eye, remember 4 things

1) You can probably 2-4 shot + expunge down anything squishy
2) you can probably take down at least half a towers health with your ult without suffering a scratch
3) Debilitating poison is an AoE slow, that needs no poison stacks to work. Poison stacks simply make it slow more.
4) you can use ignite and exhaust while stealthed without breaking it.

if the enemy has abundant elixers and wards, remember to sort of "feint" champs before engaging. test to see if they have stealth by wandering near their range, and being extra careful. If they have an elixer, try get your team to FF them. A few kills into the elixer carrier, and the gold damage youve done to the team alone will be worth your slot on your team.

other random tips include that most soloing champs are delicious (not all), always watch the minimap and try be one step ahead of a given fight (cut off escape routes rather than jumping into the frey), and you can use your ult to shoot through walls, often giving you tower kills while the enemy sits there going "dur? why I hurt?", don't rely too heavilly on stealth, as it can be countered, and try keep tabs on oracles and wards

Get yourself some Armor Penetration reds, whatever you prefer for yellow and blue (except crit dmg), and either flat health or armor pen quints.

The armor pen is essential so you can harass champions. Abuse the brush so that you're not push back to your tower.

You can go either doran's shield or vampiric scepter at the beginning, depending on how good you do. Then it's boots +5 / malady / inf edge / phantom dancers

You will have 50% crit, and around 500/600 crits. With your +50% atk speed, your Q and your R, you should be able to triple/quadruple kill if you know when and how to show up in a teamfight quite easily.

inthesto is right, don't waste money on attack speed. As soon as you've got the malady you can steadily put 2/3 stacks on a champ, use your W, and finish the 6 stacks to expunge.

What you really need to understand is that twitch's strength is not in his expunge. It is in his raw damage. The expunge should only be used to finish someone off if he manages to escape at early levels. A crit = a maxed expunge. So use it only at the end of a fight !

Have fun !

Oh, forgot masteries :

21/9/0

Go for the armor pen / atk speed / dmg to minions instead of the CD and 15% mr reduc. The damage you make from your spells is negligible, and 3% CD is really not that important with twitch. The +dmg to minions helps you to last hit early game to get strong quick, and the armor reduction, well, it's awesome!

For the summoner spells, I found Flash + Cleanse to be my best choice. Any stun means death, and you're too valuable to die just because of a warwick or an ashe. Remember you are the one making the damage. If you pop out in a teamfight, start your ulti, get focusstunned, just pop cleanse, flash away, and proceed finishing them off. Cleanse has won me so many games.

I don't play Twitch, but I've seen enough Twitch getting killed for doing this.

Don't initiate battles.

Even if you do have flash and cleanse if you try to initiate then you get focused on 'AND' lose your element of surprise. A Twtich that showed up too early in a team fight usually is dead in the next 5 seconds.

Also, just a question to Twitch players. Does Frozen Mallet work with Spray and Pray? (don't have the champ to test with)

More then anything is to pick your target and don't be a rambo.. your utli doesn't make you god those days are well past.

So keep the skills of your enemy in mind when you attack them.. I often see twitches "back stab" Tryn 1 vs 1. Which is about the most idiotic thing they can do.. the moment Tryn "dies" he becomes immortal for 7 seconds followed by a heal. Any Twitch will die before he can take Tryn down.

There are many more heroes that can really pose a big issue to back stab 1 vs 1.

You have to run with your team you don't have any disables and your extremely squishy so you will need them most of the time.

Its just me, but Twitch is very vulnerable to a good Karthus Ult. It might be good to ask someone in your team to cover you up (Morgana's Black Shield, Janna's Eye of the Storm, Soraka's Ult heal so you hopefully won't get one-shotted by that ult once you're half HP or something, of course assuming you asked for these champs during champion pick).

Have seen a Twitch die from just 2 attacks. Nidalee Spear Toss (probably at full length, since it took like more than 50% of that Twitch's HP) followed by a Karthus Ult. He pretty much raged the whole game and yeah.... (kinda ended up feeding)